Provider Demographics
NPI:1639104235
Name:NHC HEALTHCARE-MOULTON LLC
Entity Type:Organization
Organization Name:NHC HEALTHCARE-MOULTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:DORAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-424-1456
Mailing Address - Street 1:300 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1268
Mailing Address - Country:US
Mailing Address - Phone:256-974-1146
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1268
Practice Address - Country:US
Practice Address - Phone:256-974-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12597314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010-631OtherBC BS
TN3003340OtherBC BS
AL4753340SMedicaid
AL4753340SMedicaid